摘要
目的探讨胃空肠转流术联合转化治疗后根治性切除治疗胃癌合并幽门梗阻的临床疗效。方法采用回顾性描述性研究方法。收集2019年10月至2020年7月上海交通大学医学院附属瑞金医院收治的10例初始不可切除胃癌合并幽门梗阻病人的临床病理资料;男8例,女2例;中位年龄为53岁,年龄范围为41~59岁。病人均行胃空肠转流术联合转化治疗后根治性切除的"夹心疗法"。观察指标:(1)胃空肠转流术及术后情况。(2)转化治疗及并发症情况。(3)根治性切除术及术后情况。(4)随访情况。采用门诊或电话方式进行随访,了解病人术后并发症、疾病无进展生存、肿瘤复发及死亡情况。随访时间截至2019年3月。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果 (1)胃空肠转流术及术后情况:10例病人均行联合第4sb组淋巴结清扫的改良胃空肠转流术,未发生术中严重并发症、中转开腹及术中死亡。手术时间为73 min(60~87 min),术中出血量为33 mL(20~110 mL),术后肛门首次排气时间为3 d(2~6 d),术后首次进食流质食物时间为4 d(4~9 d)。1例病人术后发生吻合口出血(Clavien-Dindo Ⅱ级),经输注血制品治疗后好转。(2)转化治疗及并发症情况:10例病人中,9例完成4个疗程FLOT治疗方案,1例行2个疗程FLOT方案后发生吻合口水肿(Clavien-Dindo Ⅱ级),暂停化疗。10例病人中,部分缓解6例,疾病稳定4例。6例部分缓解病人中,4例由cT4b期降为T4a期,与横结肠系膜及胰腺包膜的关系较初次手术探查时清晰;2例治疗前淋巴结融合成团病人淋巴结明显缩小。4例疾病稳定病人中,3例淋巴结退缩情况不明显,1例初次手术探查时发现腹膜转移,化疗后影像学难以评估。10例病人中,2例化疗期间发生血糖升高(Clavien-Dindo Ⅰ级),予胰岛素治疗后好转。(3)根治性切除术及术后情况:10例病人均在转�
Objective To investigate the clinical efficacy of gastrojejunal bypass surgery combined with radical gastrectomy following conversion therapy for gastric cancer with outlet obstruction.Methods The retrospective and descriptive study was conducted.The clinicopatho-logical data of 10 initially unresectable gastric cancer patients with outlet obstruction who were admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2019 to July 2020 were collected.There were 8 males and 2 females,aged from 41 to 59 years,with a median age of 53 years.Patients underwent'sandwich therapy'of gastrojejunal bypass surgery combined with gastrectomy following conversion therapy.Observation indicators:(1)gastrojejunal bypass surgery and postoperative situations;(2)conversion therapy and complications;(3)radical gastrectomy and postoperative situations;(4)follow-up.Follow-up using outpatient examinations or telephone interview was conducted to detect postoperative complications,progress-free survival,tumor recurrence and metastasis up to March 2019.Measurement data with normal distribution were represented as Afear7±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Gastrojejunal bypass surgery and postoperative situations:10 patients received modified gastrojejunal bypass surgery combined with No.4sb lymph node dissection,without intraoperative serious complications,conversion to laparotomy or death.The operation time,volume of intraoperative blood loss,time to postoperative first flatus,time to liquid diet intake were 73 minutes(range,60-87 minutes),33 mL(range,20-110 mL),3 days(range,2-6 days),4 daysfrange,4-9 days).One patient had postoperative Clavien-Dindo grade Ⅱcomplication of anastomotic bleeding,and was improved after transfusion of blood products.(2)Conversion therapy and complications:of 10 patients,9 cases received 4 cycles of FLOT regimen.One of the 9 cases was suspended chemotherapy due to Clavien-Dindo
作者
蒋天宇
马君俊
臧潞
洪希周
何子锐
张鲁阳
郑民华
Jiang Tianyu;Ma Junjun;Zang Lu;Hong Xizhou;He Zirui;Zhang Luyang;Zheng Minhua(Department of General Surgery,Shanghai Minimally Invasive Surgery Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2021年第9期967-973,共7页
Chinese Journal of Digestive Surgery
基金
上海市临床重点专科建设项目(ShslcZdZk00102)。
关键词
胃肿瘤
幽门梗阻
胃空肠转流术
转化治疗
腹腔镜检查
Stomach neoplasms
Outlet obstruction
Gastrojejunal bypass surgery
Conversion therapy
Laparoscopy
